Yale School of Medicine, New Haven, Connecticut.
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
JAMA Netw Open. 2022 Feb 1;5(2):e220115. doi: 10.1001/jamanetworkopen.2022.0115.
Burnout is a highly prevalent issue among medical trainees, but there has been limited research characterizing burnout specifically among medical students from groups who are underrepresented in medicine (URIM).
To assess the association between components of the medical school learning environment and burnout among medical students who are URIM vs those who are not.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional survey study evaluated responses of allopathic medical students graduating from all US allopathic medical schools in 2016 and 2017 to the American Medical Colleges Graduation Questionnaire. Analysis was completed between December 1, 2019, and July 1, 2020.
Self-identification as a medical student who is URIM.
Self-reported measures of medical student overall, disengagement, and exhaustion-related burnout using the Oldenburg Burnout Inventory for Medical Students.
The American Medical Colleges Graduation Questionnaire had an 81% response rate, yielding 26 567 complete participant responses that were included the analysis. A total of 13 645 individuals (51.4%) were male, and 3947 (14.9%) identified as URIM (ie, Alaska Native, Black, Hispanic/Latinx, Native American, and/or Pacific Islander). Medical students who are URIM reported modestly higher levels of exhaustion-related burnout (mean [SD], 11.84 [3.62] vs 11.48 [3.61]; P < .001) and modestly lower mean burnout scores associated with disengagement (mean [SD], 9.24 [3.56] vs 9.36 [3.58]; P = .047). Medical students who are URIM also reported marginally less favorable student-faculty interactions in the learning environment (mean [SD], 14.09 [3.45] vs 14.29 [3.35]; P < .001). Medical students who are URIM were more likely to be in the top quartile of those who experienced exhaustion-related burnout (odds ratio, 1.19 [95% CI, 1.09-1.29]) but less likely to be in the top quartile for disengagement (odds ratio, 0.87 [95% CI, 0.80-0.94]). Regardless of URIM status, those who reported learning environment scores in the bottom quartile were more likely to experience higher rates of burnout as were those who experienced at least 1 episode of discrimination.
This survey study found that medical students who are URIM had a higher risk for exhaustion-related burnout. This burnout is likely multifactorial and could represent a resiliency or survival bias, the burden of increased responsibility, and/or recurrent discrimination. The learning environment can play a key role in mitigating burnout in both medical students who are URIM and those who are not and is deserving of further research.
倦怠是医学受训者中普遍存在的问题，但针对代表性不足的医学群体（URIM）中的医学生特有的倦怠进行的研究有限。
评估医学院学习环境的各个组成部分与 URIM 与非 URIM 医学生倦怠之间的关联。
设计、地点和参与者：这项回顾性横断面调查研究评估了 2016 年和 2017 年所有美国传统医学院的医学生对美国医学院毕业问卷的反应。分析于 2019 年 12 月 1 日至 2020 年 7 月 1 日之间完成。
自我认同为 URIM 的医学生。
使用《奥登堡医学生倦怠量表》（Oldenburg Burnout Inventory for Medical Students）报告医学生整体、脱离和与疲惫相关的倦怠的自我报告措施。
美国医学院毕业问卷的回复率为 81%，产生了 26567 份完整参与者的回复，用于分析。共有 13645 人（51.4%）为男性，3947 人（14.9%）为 URIM（即阿拉斯加原住民、黑人、西班牙裔/拉丁裔、美国原住民和/或太平洋岛民）。URIM 的医学生报告的与疲惫相关的倦怠程度略高（平均值[标准差]，11.84[3.62] vs 11.48[3.61]；P<0.001），与脱离相关的倦怠得分略低（平均值[标准差]，9.24[3.56] vs 9.36[3.58]；P=0.047）。URIM 的医学生还报告说，他们在学习环境中与教师的互动稍差（平均值[标准差]，14.09[3.45] vs 14.29[3.35]；P<0.001）。URIM 的医学生更有可能处于与疲惫相关的倦怠的最高四分位（优势比，1.19[95%CI，1.09-1.29]），但不太可能处于脱离的最高四分位（优势比，0.87[95%CI，0.80-0.94]）。无论 URIM 状态如何，报告学习环境评分处于最低四分位的人更有可能经历更高的倦怠率，而那些经历过至少一次歧视的人也是如此。
这项调查研究发现，URIM 的医学生更有可能出现与疲惫相关的倦怠。这种倦怠可能是多因素的，可能代表了复原力或生存偏差、增加的责任负担和/或反复的歧视。学习环境在减轻 URIM 和非 URIM 医学生的倦怠方面可以发挥关键作用，值得进一步研究。
